Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018

Gastroenterology. 2019 Jan;156(1):254-272.e11. doi: 10.1053/j.gastro.2018.08.063. Epub 2018 Oct 10.


Background & aims: Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States.

Methods: We estimated health care use and spending based on the most currently available administrative claims from commercial and Medicare Supplemental plans, data from the GI Quality Improvement Consortium Registry, and national databases.

Results: In 2015, annual health care expenditures for gastrointestinal diseases totaled $135.9 billion. Hepatitis ($23.3 billion), esophageal disorders ($18.1 billion), biliary tract disease ($10.3 billion), abdominal pain ($10.2 billion), and inflammatory bowel disease ($7.2 billion) were the most expensive. Yearly, there were more than 54.4 million ambulatory visits with a primary diagnosis for a GI disease, 3.0 million hospital admissions, and 540,500 all-cause 30-day readmissions. There were 266,600 new cases of GI cancers diagnosed and 144,300 cancer deaths. Each year, there were 97,700 deaths from non-malignant GI diseases. An estimated 11.0 million colonoscopies, 6.1 million upper endoscopies, 313,000 flexible sigmoidoscopies, 178,400 upper endoscopic ultrasound examinations, and 169,500 endoscopic retrograde cholangiopancreatography procedures were performed annually. Among average-risk persons aged 50-75 years who underwent colonoscopy, 34.6% had 1 or more adenomatous polyps, 4.7% had 1 or more advanced adenomatous polyps, and 5.7% had 1 or more serrated polyps removed.

Conclusions: GI diseases contribute substantially to health care use in the United States. Total expenditures for GI diseases are $135.9 billion annually-greater than for other common diseases. Expenditures are likely to continue increasing.

Keywords: Digestive System Diseases; Endoscopy; Health Care Costs; Neoplasms.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cost of Illness
  • Female
  • Gastrointestinal Diseases / diagnosis
  • Gastrointestinal Diseases / economics*
  • Gastrointestinal Diseases / ethnology
  • Gastrointestinal Diseases / therapy*
  • Health Care Costs / trends*
  • Health Expenditures / trends*
  • Health Services Needs and Demand / economics
  • Humans
  • Incidence
  • Liver Diseases / diagnosis
  • Liver Diseases / economics*
  • Liver Diseases / ethnology
  • Liver Diseases / therapy*
  • Male
  • Middle Aged
  • Needs Assessment / economics
  • Pancreatic Diseases / diagnosis
  • Pancreatic Diseases / economics*
  • Pancreatic Diseases / ethnology
  • Pancreatic Diseases / therapy*
  • Prevalence
  • Socioeconomic Factors
  • Time Factors
  • United States / epidemiology
  • Young Adult